Hospital-acquired infections before and after healthcare reorganization in a tertiary university hospital in Norway.

BACKGROUND: To evaluate hospital-acquired infections (HAIs) in somatic (all admissions other than psychiatric) and psychiatric patients admitted to a tertiary university hospital in Oslo, before and after reorganization of the Norwegian healthcare system in 2002. METHODS: Point prevalence studies were conducted four times per annum and over the period from 1995 to 2007. RESULTS: A total of 57,360 patients were studied over the whole time period: 80.5% in somatic wards and 19.5% in psychiatric wards. The HAI rate was 6.9%, of which 8.1% were somatic and 1.9% psychiatric. 13.4% of operated patients had HAI, including 6.2% due to surgical wound infections. In somatic wards, 0.6-1% were re-admitted with HAI, 15.2-23% had infections and 18-23% used antibiotics. There was a reduction in HAI until 2002. From 2003 on, HAI increased (P = 0.010) in somatic wards (P = 0.002), in non-operated patients (P = 0.024) and in extra costs. In 2002, the Norwegian healthcare system was reorganized. This reorganization led to a 30% increase in somatic patients treated from 2003 to 2007 (P = 0.054), 27% increase in the total workload per work position (P = 0.024) and 23.5% decrease in internal service work. CONCLUSION: A declining trend of HAI was observed from 1995 to 2002 at the tertiary university hospital in Norway. In 2002, the Norwegian healthcare system was reorganized. From 2003 to 2007, HAI increased significantly as did the number of somatic patients and workload at our hospital.

Nosocomial outbreaks due to amikacin-resistant tobramycin-sensitive Acinetobacter species: correlation with amikacin usage.

Fifty-seven patients in the Val-de-Grâce hospital were infected or colonized with amikacin-resistant, tobramycin-sensitive Acinetobacter spp. between January 1985 and December 1987. This resistance phenotype was attributed to the recently described 3'-O-aminoglycoside phosphotransferase (APH(3')-VI), on the basis of substrate profile and DNA-DNA hybridization, and was mainly encountered in various biotypes of A. baumannii isolated from patients. It was also encountered in saprophytic A. johnsonii isolates from the hands of 11 healthy workers among the medical staff, which provided evidence for the dissemination of an epidemic gene among different biotypes and species of Acinetobacter. A retrospective epidemiological survey showed a significant correlation between amikacin consumption and case incidence in the wards where cross-infection had occurred.